Effect of Physical Therapy vs Arthroscopic Partial Meniscectomy in People With Degenerative Meniscal Tears: Five-Year Follow-up of the ESCAPE Randomized Clinical Trial

There is a paucity of high-quality evidence about the long-term effects (ie, 3-5 years and beyond) of arthroscopic partial meniscectomy vs exercise-based physical therapy for patients with degenerative meniscal tears. To compare the 5-year effectiveness of arthroscopic partial meniscectomy and exerc...

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Published in:JAMA network open 2022-07, Vol.5 (7), p.e2220394-e2220394
Main Authors: Noorduyn, Julia C A, van de Graaf, Victor A, Willigenburg, Nienke W, Scholten-Peeters, Gwendolyne G M, Kret, Esther J, van Dijk, Rogier A, Buchbinder, Rachelle, Hawker, Gillian A, Coppieters, Michel W, Poolman, Rudolf W
Format: Article
Language:English
Subjects:
Arthritis
Clinical trials
Female
Follow-Up Studies
Humans
Knee
Knee Injuries
Meniscectomy - adverse effects
Meniscectomy - methods
Middle Aged
Online Only
Original Investigation
Orthopedics
Osteoarthritis
Osteoarthritis, Knee - surgery
Patients
Physical therapy
Physical Therapy Modalities
Tibial Meniscus Injuries - etiology
Tibial Meniscus Injuries - surgery
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Summary:There is a paucity of high-quality evidence about the long-term effects (ie, 3-5 years and beyond) of arthroscopic partial meniscectomy vs exercise-based physical therapy for patients with degenerative meniscal tears. To compare the 5-year effectiveness of arthroscopic partial meniscectomy and exercise-based physical therapy on patient-reported knee function and progression of knee osteoarthritis in patients with a degenerative meniscal tear. A noninferiority, multicenter randomized clinical trial was conducted in the orthopedic departments of 9 hospitals in the Netherlands. A total of 321 patients aged 45 to 70 years with a degenerative meniscal tear participated. Data collection took place between July 12, 2013, and December 4, 2020. Patients were randomly allocated to arthroscopic partial meniscectomy or 16 sessions of exercise-based physical therapy. The primary outcome was patient-reported knee function (International Knee Documentation Committee Subjective Knee Form (range, 0 [worst] to 100 [best]) during 5 years of follow-up based on the intention-to-treat principle, with a noninferiority threshold of 11 points. The secondary outcome was progression in knee osteoarthritis shown on radiographic images in both treatment groups. Of 321 patients (mean [SD] age, 58 [6.6] years; 161 women [50.2%]), 278 patients (87.1%) completed the 5-year follow-up with a mean follow-up time of 61.8 months (range, 58.8-69.5 months). From baseline to 5-year follow-up, the mean (SD) improvement was 29.6 (18.7) points in the surgery group and 25.1 (17.8) points in the physical therapy group. The crude between-group difference was 3.5 points (95% CI, 0.7-6.3 points; P 
ISSN:2574-3805
2574-3805
DOI:10.1001/jamanetworkopen.2022.20394